The Scarsdale Psychotherapy Self-Evaluation (SPSE)

Introduction
How do you know if your therapy is working successfully? The Scarsdale Psychotherapy Self-Evaluation (SPSE)is one way you can look at therapeutic effectiveness. Each item in the self-evaluation focuses on an aspect of therapy that is believed to be related to results. The intent of the self-evaluation is more to help you think about what is important in your therapy rather than to come up with a specific numerical value.

This tool is unique in that it is designed to be independent of the theory or school your therapy may follow. Instead, it is based on the universal processes and principles laid out in How We Heal and Grow: The Power of Facing Your Feelings.

You will be asked to rate statements in three categories: The Therapeutic Relationship, The Tasks of Psychotherapy, and Do You Feel Safe in Therapy? In all there are eighteen items, each to be scored on a scale of 1 to 5 with 5 being the most positive.

1. First few sessions felt “right” (Score_____) This has been shown to correlate strongly with overall success of therapy. If you tend to give too much benefit of the doubt or not enough when you first meet someone, ask yourself if your first impression of this therapist is better or worse than your first impressions of other people.

2. Therapist shows “accurate empathy” (Score_____) Empathy isn’t just being nice. It is a natural connection that occurs when you are able to let the therapist in on your personal world and the therapist understands just what you mean on an emotional level.

3. Therapist warmth(Score_____) Therapist warmth has been confirmed through much research to be correlated with therapeutic success.

4. Therapist “realness” (Score_____) Humans are very sensitive to others being fake. Falseness or artificiality creates a barrier to any real connection and prevents empathy from working, while realness makes it easier for a patient to open up.

5. Therapist helps me take healthy risks (Score_____) Almost all change processes involve emotional risk-taking when doing so is not really dangerous. Effective therapists help you feel connected and safe and push you a bit to go ahead.

6. Therapist has a plan, a focus, and direction (Score_____) Effective therapies feel like they are going somewhere. If yours doesn’t give you a sense of direction, then raise questions about it. Some therapists tell you explicitly what to expect and work with you to develop a kind of contract. In other traditions, you follow a method that in itself gives direction and focus. Whether it is said out loud or not, therapy should soon feel like it is leading you in a purposeful way towards what you want in life.

Part Two: The Tasks of Psychotherapy

Each of these items asks you to rate the performance of your therapy on one of several core tasks. Sometimes you may do a task without even noticing and sometimes you may have to work quite hard at it. There may be some overlap between tasks. Score how well your therapy is helping you do each task or mark “NA” if an area is not relevant to the work you are currently doing.

7. Stop “running” from feelings (Score_____) There are many ways we avoid feelings, and they all interfere with healing and growth. Negative behaviors, rationalization, keeping busy all the time, acting out instead of feeling, even anger can be cover-ups for pain. How well is your therapy helping you to stop running and to face your uncomfortable or painful feelings?

8. Healing your shame, fear, anger, and pain (Score_____) When you hold an uncomfortable feeling for at least ten seconds in a context of safety and connection, the feeling (or at least a portion of it) is transformed and no longer has the power to generate the distress it once did. This is what I call catharsis, the most common and important healing process in therapy. How well is your therapy helping you to use catharsis to heal your difficult feelings so they no longer hold you back?

9. Gain knowledge of yourself (Score_____) All therapies depend on some kind of understanding. Progressing from a vague sense to a clear concept gives us a handle on ourselves. How well is your therapy helping you to make sense of your problems and how you can heal and grow?

10. Reform your conscience or core values (Score_____) Our superego or conscience judges things according to strongly internalized templates. These templates include values, attitudes, ideals, and prohibitions. When we live up to them, we feel pride. When we don’t we feel guilt or shame. The problem is that sometimes those templates are wrong or unhealthy. When they are, we may feel shame or guilt when we shouldn’t. How well does your therapy help you identify and resist unhealthy values and judgments?

11. Voluntary Behavior Change (Score_____) Behavior patterns can undermine our lives by covering up feelings we need to face and by supporting unhealthy attitudes or values. Many kinds of dysfunctional behavior patterns can sabotage your life. Most of the time these started out as ways to shield you from feelings that once were too much to handle. How well is your therapy helping you to make healthy changes in behavior?

12. Reevaluate secret wishes and plans (Score_____) Do you repeatedly find yourself blocked from the things that are most important to you in life? Could you be sabotaging yourself? If so, you may have a secret world of wishes and plans in conflict with secret prohibitions. How well is your therapy working to help you clarify these issues and get unstuck?

13. Restart arrested development (Score_____) Regardless of your age, growing emotionally and maturing involve taking emotional risks, practicing new behaviors, and going through the feelings that result. Often pride and shame block us from recognizing areas of immaturity. How well is your therapy working to help you face areas where you need to grow, practice more mature behaviors, and go through the uncomfortable feelings that accompany change?

Part Three: Do You Feel Safe in Therapy?

Please give each item a score from 1 to 5, where 5 is most positive.

14. Therapist makes it safe to criticize or disagree (Score_____) This is important in any therapy, and may be the key to resolving unfinished business from the past that has been “transferred” to the therapeutic relationship. Therapists should put personal feelings aside and work with you to see what part of the problem is yours and what part is theirs. How well is your therapy working to help you resolve difficult issues with your therapist?

15. Therapist makes it safe to share highly personal material (Score_____) Many thoughts and feelings come up in therapy both from the past or in the present, including feelings related to the therapist. Therapists need to be respectful and professional while making it as easy as possible to make these feelings part of what you talk about. Sometimes the therapist’s feelings and emotional reactions may be part of the interaction. These, too should be handled in a way that keeps the focus on your treatment.

16. Therapist only makes promises that can be kept (Score_____) Therapists can be tempted to promise more than they can realistically deliver. However, you need and deserve a therapist who will be reliable and firm, even if you are putting on pressure. When promises are broken, it is hard to forgive, and the relationship may be seriously damaged. How well does your therapist manage expectations and set limits?

17. Therapist avoids setting bad precedents (Score_____) Bad precedents are similar to unrealistic promises but are unspoken. For example, if your therapist goes along with you in avoiding an important task—say, not addressing a certain difficult area—you may feel better in the short run but see your progress blocked in the long run. How well does your therapist avoid setting bad precedents?

18. Therapist maintains safe boundaries (Score_____) Therapy is about you, not the therapist. The reason why therapists don’t tell you too much about themselves is to avoid making the therapy about the therapist and his or her needs and to keep it focused on you. Physical boundaries are maintained to prevent arousing natural feelings that have the power to take the focus away from your healing and growth. If it feels as though your therapist is dealing with you in a way that is (or feels) inappropriate, or if his or her self-interest is getting in the way, then you can be hurt and your therapy damaged. Do you feel safe about the boundaries in your therapy? If you have questions, talk to an outside person you trust.

For areas where the evaluation suggests a problem, it may help to bring it up with the therapist and try to resolve it so as to improve the success of the therapy. If it can’t be resolve, that would bring the therapy into question. You are right, that the numerical scores do not have great significance other than pointing to possible problem areas.

I think having independent frameworks for patients, clinicians and researchers to evaluate the impact of psychotherapy at the individual level is really valuable. Thank you for publishing this.

There is room for improvement: In addition to other commenters concerns that a scoring key isn’t provided I am surprised there are items that elicit information specific to certain schools of psychotherapy alone (ref: ‘superego’). Furthermore, I am surprised that this scale isn’t based around the evidence-based determinants of success in psychotherapy from the common-factors approach – for instance: ‘goal consensus’ between the patient and therapist.